We visited Cranham Court on 12 April 2016, than carried out a follow-up visit to see what had been done there since that original visit, on 16 March 2017. We carried out a further full visit on 16 January 2018.
Following the original visit to the home, the team recommend as follows:
- That all toilets, wash hand basins and bathing areas be descaled and thoroughly cleaned as a matter of priority.
- That staff ensure that all residents are able to use the call bell system and check regularly to ensure that they have the call bell button within easy reach of their person.
- That, during the course of refurbishment, consideration be given to incorporating toughened glass on notice boards in order to ensure that notices are secure and cannot be removed
- That photos of the permanent staff, with names and titles, be displayed in the foyer, which should also be brightened.
- That the condition of decorations and carpets be reviewed and deep cleaning arranged where needed.
- While acknowledging that all residents have the right to stay in bed or in their rooms if they so wish, those residents who are capable of moving around the home should be encouraged to do so
- That ambulance staff be encouraged to return blankets to Queen’s Hospital via a laundry bag on the ambulance.
- That patients who are sent to hospital be given a set of clean clothes for their return to the care home when discharged.
The team would like to thank all staff and patients who were seen during the visit for their help and co-operation, which is much appreciated.
This report relates to the visits on 12 April 2016 and and is representative only of those residents, carers and staff who participated. It does not seek to be representative of all service users and/or staff.
At the time of the follow-up visit, there were 56 residents. The team spoke with 5 members of staff, 2 relatives of residents and 9 residents in total during that visit.
The team felt well received by the receptionist when they arrived and were immediately struck by the Reception area which was bright and welcoming. The reception area also displayed useful information for relatives and other visitors, such as the report of a CQC inspection that had been undertaken in November 2016, other informative material and a stand that showed the current week’s daily menu’s for relatives and other visitors information.
As this was a review meeting, the team concentrated on discussing areas of improvements that had been flagged up and were related to the previous Healthwatch Report of April 2016 and the CQC report of November 2016.
There was discussion of the procedures regarding DBS and it was confirmed that the home have all staff covered by DBS and renewals would take place every 3 years. The home had undertaken a complete revamp of all their procedures and documentation and they showed the team records for the following areas: staff meetings, maintenance records, registered nurses meetings, meetings between both units, and residents meetings. The meetings has helped the communication between the staff, residents and the management and were improving the quality of care.
The maintenance records were very helpful as they indicated that the home is continually improving the environment (although this is an ongoing activity because of the age and size of the building) by replacing damaged or worn carpets; keeping all the facilities, such as the toilets free from limescale and in good repair; plus decorating areas within the home so that the environment is clean, tidy and homely. Observations on the day of the visit confirmed this information and discussions with relatives and their families endorsed that meetings had taken place and had been very informative and useful. Due to the season, there was no garden furniture in place in the courtyard but apparently in the warmer months this area was very popular and there were frequent events organised in this area. Many of the residents who would like to go outside are usually accompanied as their mobility is limited.
The Dementia unit was a very bright and interactive area and the events co‐ordinator undertook various activities with the residents in this unit that involved reminiscence sessions, gentle keep fit and other specialised activities. It was observed that Doll therapy was in place with certain individuals. The hairdresser was also attending to residents on the ground floor of the unit. The CQC had noted in their report that there were inconsistencies as regards medication - that records, such as incident and Mars sheets were not always completed correctly and of problems with the ordering medication. The home had since looked again at their procedures and had discussed ordering procedures with the pharmacist and GP, and they now had in place a 28 day repeat prescriptions arrangement rather than a 3 month agreement, which was working well. The Management had also brought in a very strict procedure and the Mars Sheets were now reviewed daily by the Manager or Assistant Manager and signed off as appropriate.
Mars Sheets and the procedure checking book were checked during the visit.
The team felt that, all in all, the home had made huge attempts to address the improvements indicated by the CQC and Healthwatch. The Management were extremely open, helpful and used records to validate these improvements.
The The Matron and her deputy were fully engaged with the process and answered the team's questions fully, allowing them access to the following records: Mar Charts, minutes of staff meetings, maintenaince records, residents meetings, meetings of both units, meetings with nurses.
Following the visit in January 2018, we made the following recommendations:
Although the home is well-decorated, consideration should be given to providing more variation in the decor to help it be more user-friendly, so people can find their way around the home. It is considered good practice in homes accommodating people who live with dementia to ensure there are contrasting colours in corridors and doors to reduce the possibility of people becoming confused by their surroundings.
In addition, the residents who are frail and cannot get out might find it stimulating to be able to listen to more music. It might be beneficial for the management to explore with the nearby Coopers’ Company and Coborn School whether student choirs or musical groups could visit the home from time to time.
Finally, the home may wish to consider whether changing the morning shift start time to 8am would improve the possibility of staff recruitment by enabling a maintenance assistant to provide a shuttle service to collect staff from the town centre or railway station.
On 25 October 2018, we carried out a follow-up visit to the visit we had made on 16 January 2018.
On arrival, our team was told that the Manager was at Sycamore, another home owned by The Holmes Care (Group) Limited, which had taken over the ownership and running of the home since our previous visit.
The Deputy Manager met the team and was happy to see them. She had been at Cranham Court for some time and reported that the previous Manager (Matron) and Owner had relinquished all control and involvement with the home. The new manager had started in March 2018.
All rooms but one (which was being decorated) in the home were occupied. The Deputy Manager showed us one room on the ground floor, which was occupied by a couple who were watching the TV together – the team were introduced to them and they said they were quite happy there. Their room was large, sunny and quiet, with lovely views which suited them. Although the old main house had been extended quite a bit on both sides, the rooms are quite a good size, light and airy, with lovely views of the grounds. 25 of the residents were bed-bound.
The Deputy Manager said the only real problem they had remained recruiting and retaining staff, with too much reliance on an agency based in Ilford. Their shift patterns continued to start at 7am but the Deputy Manager told the team that that was not an issue despite the difficulty some staff might experience in getting to work on time. She was sure that the shift pattern was not the reason why they experienced problems in recruitment. Staff do 13 hour shifts with one hour off for which they are not paid. Carers are paid £8.45/hour.
The Deputy Manager showed the team around: everywhere looked clean and tidy, although some pelmets were adrift. A maintenance person was busy painting a corridor - all doors in the Dementia Unit are painted in different colours. The RGN on the Dementia Unit was in her office and met the team. Bedrooms looked clean and tidy - some people had personal possessions in their rooms. The team were told that the home struggled to get family involvement, especially with activities like memory books. Considering this was an unannounced visit, things looked good although the did not have opportunity to look at paperwork or record keeping. There was evidence that the dedicated training room on the ground floor was being used.
All 21 beds in the Dementia Unit, Woodlands, were fully occupied. The team met the full-time Activities Co-ordinator, who works with a part-time colleague, but no activities were taking place during the visit. The TVs in both lounges were on. They do some 1 to 1 work when they can.
There were at least 4 RGNs on duty during the visit and the team met several carers, who informed the team that they were meticulous over medication administration and control.
The kitchen staff were clearing up after lunch.
The team met a man who had just been admitted, following discharge from the Royal London Hospital and he was having a cup of tea and biscuits. He had a relative with him. A member of the team met someone she knew in the main lounge and he seemed quite at home - he was being cared for because he has severe diabetes.
Although the home is reluctant to accept residents discharged back from hospital after 5pm, it was sometimes hard to enforce this. The Deputy Manager advised that residents were always accompanied to hospital, although it was unclear whether the staff concerned remained with the resident once they had been handed over to hospital staff. The home try to involve residents’ families when a resident has to be admitted to hospital.
Click here for information about Cranham Court.
Click here for the CQC inspection report